Education best way to keep down rising costs

Joan Mileski began to understand the correlation between her blood-sugar levels and her health almost immediately after attending Moses Taylor Hospital’s diabetes education program in March.

“The class taught me to eat more carefully and to have a healthy lifestyle,” said Ms. Mileski, 72, of Throop, who was diagnosed with diabetes in February. Ms. Mileski’s course was covered by her insurance company.

Insurance companies are more willing than ever to pay for instructional courses for newly diagnosed diabetics, but scores of diabetic Americans still face serious affordability and accessibility issues for health insurance, medical professionals said.

“It seems every year we’re fighting just to maintain coverage for people, mostly for rising costs for supplies,” said Lauren Wiley, American Diabetes Association director for Northeastern Pennsylvania.

“Just think of how many times a day someone checks their insulin. There’s so many other supplies to buy from creams to special shoes.”

A 2005 ADA study, “Health Insurance and Diabetes: The Lack of Available, Affordable, and Adequate Coverage,” highlighted some of the common problems diabetics face accessing care with and without insurance.

Even individuals insured by their employers or by other means, often have trouble buying supplies such as blood-sugar test strips — which can cost around $100 per box of 100 strips.

Meanwhile, 25 percent of adults need to purchase health insurance on their own, at some point during a three-year period, if they aren’t eligible for employer benefits or government insurance, according to the study.

Individuals periodically face gaps in coverage from unemployment, but in most states, patients’ pre-existing conditions disqualify them for stop-gap coverage.

Oftentimes, diabetics aren’t aware of the federal or state benefits for which they’re eligible.

Even when state laws promote individual stop-gap coverage or make it mandatory, it can be too expensive for applicants.

Sometimes patients earn too much to qualify for the state or federal insurance coverage, but they still don’t have enough money to buy private insurance.

Plus, “very few government laws or programs exist to help people who have health insurance that is inadequate to cover their medical needs,” according to the study.

“As a result, an increasing number of insured Americans are under-insured.”

“High medical bills are the leading cause of personal bankruptcy in the United States,” the study continued. “And 80 percent of the people who file for bankruptcy for this reason have health insurance.”

In a federal experiment involving Medicare patients, Geisinger Health System went a different route to keep costs down. Instead of cutting benefits or denying older patients coverage, the Geisinger Clinic reduced diabetics’ medical costs by having more healthy patients.

The health system and its clinic use a sophisticated electronic medical record system to track each patient and doctors keep them well-informed about how to care for themselves.

The federal Centers for Medicare and Medicaid Services commended Geisinger Health System in July for ensuring its diabetic clients on Medicare are healthy and their conditions are managed well.

“I think patients expect doctors and nurses to tell

them what to do,” said Sabrina Girolami, director for care coordination at Geisinger Health Plan. “We believe in empowering people through education. The adult person wants to be in charge.”

Lorraine Dancsak and Jane McLaughlin, certified diabetes educators at Moses Taylor Hospital, have more than 20 years experience watching the evolution of diabetes care and insurance coverage for patients.

Ms. Dancsak and Ms. McLaughlin said insurance companies and doctors now understand the importance of educating patients about their conditions. Education alone can help keep care costs down, they added.

“Over the last few years, the doctors are really much more aggressive in treating diabetes in terms of not being content with mediocre blood-sugar levels,” Ms. McLaughlin said. “They’re more aggressive in educating earlier, using more therapies and being positive.”

Despite the insurance affordability and accessibility challenges many diabetics face, Community Medical Center nutritionist Marsha Foy said diabetes education is critical and worthy of coverage.

“All the medicines in the world are not going to make (Type 2) diabetes go away,” Ms. Foy said. “(Curing diabetes involves) a change in society’s eating habits and behaviors and a desire to get healthy. If people don’t have that desire they’re going to eat themselves to death.”

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